Clinical Procedural Skills Research Articles

Direct Observation of Procedural Skills (DOPS) in Enhancing Clinical Competencies of Postgraduate Medical and Dental Education: A Scoping Review

Background: As postgraduate medical or dental education students, most of us will have come across Direct Observation of Procedural Skills or DOPS. DOPS promoted clinical effectiveness by evaluating practice-based skills in the authentic organizational context, and subsequently proactively feeding back the learning to learners. This scoping review sought to synthesize the work done in determining DOPS's effectiveness in enhancing clinical competencies in some fields of medicine and dentistry. Methods: The study was carried out by using the following search engines: PubMed, Medline, Google Scholar, Science Direct, SID, Medlib and Google searched unpublished sources (Gray literature) and selected references (reference of reference) by typing the following keywords: (DOPS), clinical competencies, postgraduate medical and dental education. Results: From 215 papers 40 were analyzed and together demonstrated the efficiency of the Direct Observation of Procedural Skills (DOPS) as an assessment tool for numerous medical and dental profiles. It was revealed that DOPS improved procedural confidence, procedural performance competence and general clinical skills, all over the world. In their views, learners and educators overestimated the usefulness of DOPS and acknowledged its function of enhancing clinical competencies and offering feedback. The participants encountered some difficulties such as time limitations, coordination problems, and curriculum mismatch Nevertheless, DOPS was much more effective than traditional approaches in increasing satisfaction and reliability of the assessments in various medical training settings. Conclusion: In the context of postgraduate medical and dental education and training, the DOPS assessment tool was found to be very effective in enhancing clinical competencies and procedural skills. However, the successful implementation has the points that need to be attended like the training of the assessors and standardization although there are benefits of the same. Further studies were encouraged to investigate ways of enhancing the use of DOPS and how best it could be incorporated into post-graduate training

Applied Improvisation: Putting Behavioral Skills Center Stage in Simulation-Based Team Training.

Behavioral skills, sometimes referred to as nontechnical skills or team-based skills, are fundamental to simulation-based team training. These skills should be afforded the same deliberate practice and development as clinical knowledge and procedural skills in health care education. Applied improvisation, the use of theater games designed to improve individual and team performance, is gaining traction in health care education to train behavioral skills. Simulation educators are experts in experiential learning with debriefing and therefore well poised to incorporate applied improvisational exercises into team training activities.

Modified Laryngeal Forceps for Arytenoid Cartilage Dislocation Caused by Endotracheal Intubation: A Retrospective Case-Control Pilot Study.

Background: Arytenoid cartilage dislocation is considered as a rare laryngeal injury and closed reduction is commonly used as the first choice for the arytenoid dislocation. However, the tools of closed reduction vary, and there is no dedicated tool for closed reduction, and the treatment outcome varies from person to person. This study compared the treatment outcome of the modified laryngeal forceps and traditional laryngeal forceps. Material and Methods: This study conformed to the strengthening the reporting of observational studies in epidemiology guidelines regarding retrospective studies. From May 2021 to February 2023, the records of 28 patients with arytenoid cartilage dislocation caused by endotracheal intubation were reviewed. They were divided into the traditional group (n = 14) and the modified group (n = 14) by gender. Indirect or direct laryngoscopy, video stroboscopy, high-resolution computed tomography, and cricoarytenoid joint 3-dimensional reconstruction were used to evaluate arytenoid position and motion. Clinical characteristics, voice function, procedural skill, and treatment outcome for each case were recorded. Results: Each patient was diagnosed with arytenoid dislocation caused by endotracheal intubation. There was no significant difference in the treatment outcome between the traditional group and the modified group (P > .05). However, the median time interval between closed reduction and the return of normal voice in the traditional group was 31.08 ± 10.56 days, which was significantly longer than the median time of 17.92 ± 3.83 days in the modified group (P < .05). Conclusion: Closed reduction with the modified laryngeal forceps under local anesthesia is an effective and safe procedure. Compared with traditional laryngeal forceps, the modified laryngeal forceps can shorten the treatment duration.

Self-regulated learning processes across different physiotherapy clinical procedural skills and time intervals: A SRL microanalysis study

Purpose of the study The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval. Methods SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students’ use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval. Results An individual student’s use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances. Conclusion Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.

Acute Exacerbation of COPD.

This case is targeted to emergency medicine residents of all levels. Shortness of breath (SOB) is one of the top ten most common chief complaints seen in the Emergency Department, accounting for close to 10% of presenting complaints.1 An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a frequent culprit, accounting for roughly 15.4 million visits and 730,000 hospitalizations per year.2 The diagnosis of treatment of mild to moderate AECOPD can be relatively uncomplicated; however, multiple factors can increase the complexity of management and pose additional challenges that the emergency physician (EP) must be prepared for. Severe AECOPD can necessitate the need for both Non-invasive positive pressure ventilator (NIPPV) such as bi-level positive airway pressure (BiPAP) as well as emergent intubation. Furthermore, managing the ventilator settings in patients with an AECOPD is far from routine, requiring an intricate understanding of pulmonary physiology.3. By the end of this simulation, learners will be able to (1) assess for causes of severe shortness of breath, (2) manage severe COPD exacerbation by administering appropriate medications, (3) identify worsening clinical status and initiate NIPPV, (4) assess the causes of hypoxia after establishing endotracheal intubation and, (5) identify indication for needle decompression and perform chest tube thoracostomy. This simulation was conducted with a high-fidelity mannequin with a separate low fidelity chest tube mannequin that allowed for hands-on practice placing a chest tube. A total of 16 PGY-1 residents participated in the simulated patient encounter. Following the simulation and debrief session, all residents were sent a Likert scale survey via surveymonkey.com to assess the educational quality of the simulation. The survey contained the following questions; 1) Overall, this simulation was realistic and could represent a patient presentation in the Emergency Department, 2) Overall, the case contained complexity that challenged me as a learner, 3) This case helped to expand my medical knowledge, 4) I feel more confident in diagnosing and treating AECOPD, 5) I feel more confident in recognizing the indications for NIPPV and intubation, 6) This simulation offered an opportunity to improve my procedural skills, 7) I feel more confident in setting up the ventilator, 8) I feel more confident in addressing ventilator alarms. Following the simulation and debrief session, all the participants (n=16), were provided a survey to assess the educational quality of the simulation. There were a total of 12 respondents and a hundred percent of them agreed or strongly agreed that the case contained complexity that challenged them. All of the respondents agreed that the simulation case was realistic and that the case helped expand their medical knowledge. Furthermore, all the learners agreed or strongly agreed that the case helped them in improving their procedural skills. This case combines a mixture of high fidelity and medium fidelity components to encompass both clinical knowledge and procedural skills. This case is effective in expanding beyond the basic approach to managing an AECOPD patient and forces learners to address clinical deterioration, escalate airway interventions, manage ventilator settings, and address ventilator alarms, including placement of a chest tube. Residents commented that this case was very realistic and particularly challenging because it highlighted gaps in their clinical knowledge and procedural skills. Residents were most challenged by identifying when to escalate care as well as how to manage ventilator settings in AECOPD patients. Acute exacerbation COPD, intubation, positive pressure ventilation, ventilator alarms, chest tube thoracostomy.

World Federation for Interventional Stroke Treatment (WIST) Multispecialty Training Guidelines for Endovascular Stroke Intervention

IntroductionToday, endovascular treatment (EVT) is the therapy of choice for strokes due to acute large vessel occlusion, irrespective of prior thrombolysis. This necessitates fast, coordinated multi-specialty collaboration. Currently, in most countries, the number of physicians and centres with expertise in EVT is limited. Thus, only a small proportion of eligible patients receive this potentially life-saving therapy, often after significant delays. Hence, there is an unmet need to train a sufficient number of physicians and centres in acute stroke intervention in order to allow widespread and timely access to EVT. AimTo provide multi-specialty training guidelines for competency, accreditation and certification of centres and physicians in EVT for acute large vessel occlusion strokes. Material and methodsThe World Federation for Interventional Stroke Treatment (WIST) consists of experts in the field of endovascular stroke treatment. This interdisciplinary working group developed competency – rather than time-based – guidelines for operator training, taking into consideration trainees' previous skillsets and experience. Existing training concepts from mostly single specialty organizations were analysed and incorporated. ResultsThe WIST establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in EVT. WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. ConclusionsWIST multispecialty guidelines outline competency and quality standards for physicians and centres to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SummaryThe World Federation for Interventional Stroke Treatment (WIST) establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in endovascular treatment (EVT). WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. WIST multispecialty guidelines outline competency and quality standards for physicians and centers to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. Simultaneous publicationThe WIST 2023 Guidelines are published simultaneously in Europe (Adv Interv Cardiol 2023).

World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention.

Today, endovascular treatment (EVT) is the therapy of choice for strokes due to acute large vessel occlusion, irrespective of prior thrombolysis. This necessitates fast, coordinated multi-specialty collaboration. Currently, in most countries, the number of physicians and centres with expertise in EVT is limited. Thus, only a small proportion of eligible patients receive this potentially life-saving therapy, often after significant delays. Hence, there is an unmet need to train a sufficient number of physicians and centres in acute stroke intervention in order to allow widespread and timely access to EVT. To provide multi-specialty training guidelines for competency, accreditation and certification of centres and physicians in EVT for acute large vessel occlusion strokes. The World Federation for Interventional Stroke Treatment (WIST) consists of experts in the field of endovascular stroke treatment. This interdisciplinary working group developed competency - rather than time-based - guidelines for operator training, taking into consideration trainees' previous skillsets and experience. Existing training concepts from mostly single specialty organizations were analysed and incorporated. The WIST establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in EVT. WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. WIST multispecialty guidelines outline competency and quality standards for physicians and centres to perform safe and effective EVT. The role of quality control and quality assurance is highlighted.

Reflections on our experiences of delivering a simulation-based education programme for medical support workers

International Medical graduates (IMGs) contribute significantly to the NHS medical workforce, but often face unique challenges which are not always catered for within medical education [1]. The Medical Support Worker (MSW) role was created in response to the COVID-19 pandemic, providing an opportunity for doctors seeking GMC registration to gain clinical experience within a supervised NHS placement [2]. Our Trust’s Postgraduate Medical Education department was asked to deliver a teaching programme to the Trust’s first cohort of 29 MSW’s, 28 of whom are from Myanmar. The aims of this programme were to provide support for the MSW role and preparation for working as an NHS doctor. Based on a scoping questionnaire of the MSWs’ perceived learning needs and our prior experiences of working clinically with IMGs, we developed an innovative tailored programme, consisting of three days covering frequently-encountered clinical scenarios, non-technical, procedural and communication skills. Throughout the teaching programme, several themes unique to MSWs became apparent. These learners’ previous experiences of medical education were predominantly behaviourist, consisting of didactic teaching in which learner contribution was not encouraged. Their only prior experience of simulation was for assessment. It was therefore vital that we ensured a psychologically safe environment in which they felt confident and were encouraged to participate in near-peer learning. We achieved this by explicit conversations about different styles of medical education and modelling these behaviours consistently. A particular challenge we encountered was introducing the learners to the hidden curriculum of the NHS [3]. This refers to the behaviours and values that form an acceptable professional identity and may differ between international healthcare systems. It became apparent during simulation that dedicated human factors training would be valuable. This was integrated via two half-day sessions focussing on non-technical skills and communication-based simulation. Cultural differences, especially in communication styles, became apparent. This included: a doctor-centred versus patient-centred agenda; challenges inherent to communicating in a second language; and different cultural values and legal frameworks. We endeavoured to expose our learners to scenarios that provoked discussions around these issues, for example communicating with a teenager requesting contraception. IMGs face unique challenges when entering the NHS workforce and it is inherent upon medical educationalists to consider and meet these needs. We have identified three major themes (different educational models; the hidden curriculum of the NHS; and cultural differences) that must be addressed to ensure high quality care and patient safety. 1. Slowther A, Lewando Hundt GA, Purkis J, Taylor R. Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study. J R Soc Med 2012: 105:157 –165 2. Temporary Medical Support Worker (MSW) Secondary Care – Job description and person specification. NHS England and NHS Improvement. 3. Hafferty FW, O’Donnell JF. The Hidden Curriculum in Health Professional Education. 2014.Hanover, NH: Dartmouth College Press

VIDEO BASED LEARNING AN INNOVATIVE TEACHING METHOD ON CLINICAL PROCEDURAL SKILL AMONG UNDER GRADUATE NURSING STUDENTS

Video-Based Learning refers to learning experiences facilitated through video. Video based learning helps to improve learner's retention, enables micro learning and on demand learning. Objective: To determine the student perception on Video Based Learning of Clinical Procedural skill. Design: Non experimental Descriptive Survey Design. Settings: Selected Nursing College of Metropolitan city. Methods: Selected nursing procedure was video recorded at the time of demonstration which was uploaded in the Google Classroom for the students for later reference. Students perception about the Video Based Learning was obtained. Results: Descriptive Statistics used for data analysis. Student perception on Video Based Learning collected using 5 point Likert Scale. Majority of the students given positive perception about the new teaching method. Overall rating of the Likert scale was 4.44. Conclusion: Video Based Learning helped the students to reinforce the procedural steps and arouse the interest of learning.

Comparison between residents with a 6-year medical program and a 7-year medical program in terms of objective structured clinical examination performance in postgraduate year training in Taiwan: a 2-group pre- and post-test non-synchronized study

PurposeIn 2013, medical schools in Taiwan implemented a 6-year medical program that replaced the previous 7-year medical education program. The postgraduate year (PGY) program was also extended from 1 year to 2 years. The new program is characterized by diversified teaching, integration of medical skills, a system-oriented curriculum, and the implementation of primary care and clinical thinking training. The purpose of this study was to examine whether postgraduate residents who learned under the new program have better patient care skills than those who learned under the previous program.MethodsOf 101 residents in the PGY program at Taipei Veterans General Hospital, 78 were trained in the 6-year program, while 23 were trained in the 7-year program. During the PGY training, 2 objective structured clinical examinations (OSCEs) were used to evaluate clinical reasoning, communication skills, and procedural skills at the beginning of the training and after 11 months of training, respectively. The scores of each OSCE and the rate of improvement of the pre- and post-tests were analyzed.ResultsResidents trained in the new program scored higher on clinical reasoning (P<0.001) and the total scores of the 3 tested skills (P=0.019) on the pre-test. In terms of improvement, residents educated in the previous system improved more in clinical reasoning than those educated in the new education system.ConclusionThe new medical education program, which emphasizes clinical thinking, improved residents’ clinical skills. The PGY program was effective in improving the clinical performance of residents who were educated in the previous system.

Preparedness of house officers for independent clinical practice: are we there yet?

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; The essential goal of any medical school is to train medical graduates to work as independent clinicians. Inadequately prepared doctors put the well-being of patients at a great risk. The objective of the study was to evaluate the preparedness for independent clinical practice of house officers who graduated from medical schools with the traditional discipline-based curriculum, from both public and private sectors, and with high and low merit.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A quantitative correlational study was conducted by using an already validated questionnaire. A total of 241 house officers who graduated from public and private sector medical schools from Lahore, Pakistan, with high and relatively low merit, were selected. The data from the filled responses were analyzed by using Statistical Package for the Social Sciences version 25.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the 241 respondents, 152 (55.3%) were female and 89 (32.4%) were male. The mean age of the respondents was 24.19 &amp;plusmn; 0.91 years. The difference in mean score between the public and private sectors was significant in the subscales of clinical skills, procedural skills, and patient management.&lt;br /&gt;Analysis of free-text responses showed a deficiency in procedural skills, communication skills, time management, and management of acutely ill patients in the emergency department in both classes of medical schools. Many graduates suggested early clinical exposure with hands-on training and the addition of modules of ethics and medical laws in the curriculum.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The medical graduates lack pertinent training in professionalism, ethics, medical laws, and communication skills which may hamper their appropriate preparedness before dealing directly with the high turnover of patients during house jobs.&lt;/p&gt;

A longitudinal study assessing the impact of ongoing COVID-19 pandemic among hematology-oncology trainees.

11033 Background: Hematology-Oncology (HO) trainees faced significant challenges due to the COVID-19 pandemic highlighted by a previous survey (Durani, Urshila, et al. "Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and Qualitative Assessment." JCO Oncology Practice (2021): OP-21). Despite the positive impact of effective vaccines, the pandemic is still ongoing; thus, the challenges remain. Our aim is to evaluate how well the trainees have adapted to changes in their clinical training environment after the early phase of the COVID-19 pandemic. Methods: A cross-sectional internet-based survey (Shih, Grace, et al. "The impact of the COVID‐19 pandemic on the education and wellness of US Pediatric Anesthesiology Fellows." Pediatric Anesthesia 31.3 (2021): 268-274) from December 10, 2021, to January 10, 2022, was obtained from the trainees enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited HO fellowship programs in the United States in their fourth (PGY4), fifth (PGY5), and sixth (PGY6) postgraduate year. Results: The survey was completed by 102 trainees. Demographics of the participants are reported in Table. Interestingly, 51% reported an impact of COVD-19 on their employment plans, primarily due to the inability to interview in person (24%, n=23). Trainees experienced several stressors due to the pandemic, including fear of getting sick from a patient (71%) or a coworker (66%). Approximately 27% (n=26) experienced mental health issues requiring additional care. Less than one-third of the trainees were concerned about clinical expertise and procedural skills. Trainees also felt that the change of conference to virtual format impacted their learning activities compared to in-person education (66%, n=64). Most trainees (52%, n=53) reported limited involvement in COVID-related research and journal club education. Most had access to socialization (59%, n=60), virtual office hours (70%, n=72), and telehealth visits (83%, n=85). Female trainees (18%) were more likely to seek mental health care than the male trainees (7.8%) (P=.02). Female trainees (33%) also reported facing more challenges in their employment plans compared to males (16%) (P=.003). Conclusions: Our study highlights the challenges experienced by hematology-oncology trainees with the ongoing COVID-19 pandemic and reveals the gender gap related to employment plans and seeking mental health care. [Table: see text]

Maximizing Opportunities for Anatomy Learning: Use of Authentic OSPE as Part of Assessment in Anatomy

In the care of patients, a practicing physician performs a selected and integrated set of individually skillful acts that are pertinent to each patient encounter. These include, for example, engaging the patient in a professional relationship, taking a clinical history, performing a mental and physical examination, performing, or initiating clinical tests or procedures, and undertaking diagnostic and therapeutic interventions. From an analytic perspective, these component acts of medical care reflect the generic competencies which comprise the practitioner’s basic clinical method1.Skill learning requires the demonstration of skill proficiency that must be observable. This observation is necessary to evaluate performance. Moreover, learners need repeated and deliberate practice followed by constructive feedback to continually refine and improve their performance of the skill. Therefore, the evaluation of skill proficiency requires the direct involvement of a trained observer, such as a supervising expert or an experienced patient2.The utility or value of assessment items (question used in an examination) depends on; their validity, reliability, educational impact, cost, and acceptability3. For instance, a written examination item had good value and utility if it tests learning in the knowledge domain. In the same way, a written examination item has poor utility if used for testing psychomotor skills.The so‐called OSPE (Objective Structured Practical Examination) has its origins in physiology4 where competence in performing physiological tests (e.g. Rinne’s test) are examined through observation by an examiner using a structured checklist (similar to Objective Structured Clinical Examination, OSCE). Within the context of medical education, an activity could be regarded as a clinical skill if it satisfies three conditions namely, the activity must be demonstrable, observable, and employs using knowledge, psychomotor and attitude components of learning (Fig 1).Anatomy learning in medical education underpins the development of clinical reasoning, understanding of medical imaging, the basis of clinical procedures, and physical examination of patients. An authentic utilization of the concept of OSPE in anatomy education should be in the context of evaluating a true skill competence. This will include evaluating competence in physical examination and/or clinical procedural skill (Fig 2). In current undergraduate medical education, these skills and more are now part of a comprehensive and integrated clinical skills curriculum.References AAMC, (2005). Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Association of American Medical Colleges. Duvivier et al. (2011) BMC Medical Education 11:101 Van der Vleuten CPM, (1996). Advances in Health Sciences Education 1 (1), 41‐67 Nayar U et al. (1986). Med Educ 20 (3):204‐9

Start here- principles of effective undergraduate training.

Obstetric and gynaecology undergraduate training is an intense time for learners as they encounter various health conditions related to women's health and also learn about pregnancy care and birth. The experience is directed to familiarise students with basic clinical management of gynaecological conditions, also develop communication and related core examination and procedural skills. Similarly, midwifery training encompasses independent care of low-risk pregnant women and assist in care of high-risk pregnancy in partnership with obstetricians. Although its necessary to acquaint most learners with core clinical skills in obstetrics and gynaecology, learning opportunities on patients can be limited, due to the intrusive nature of women's health examination. Simulation Based Education (SBE) can facilitate learning hands-on clinical examination and procedural skills, using realistic part-task and high-fidelity simulators prior to approaching patients. This can apply to both medical and midwifery undergraduate training, further creating opportunities for professional interaction and shared learning space to facilitate interprofessional education. IPE has been shown to improve professional relationships in practicing clinicians. This learning pedagogy can be applied in the undergraduate setting as well, to decrease risk of conflict and appreciate roles of other interprofessional staff in future clinical practice. In this chapter we highlight some challenges faced by medical and midwifery undergraduates in their learning from a global perspective. We also describe some teaching and learning initiatives that can be applicable across various settings of obstetrics, gynaecology medical undergraduate and midwifery teaching with relevant case studies to facilitate new graduates preparedness for practice.

Development of a core set of clinical skills for pharmacist prescribers working in general practice: a Delphi study

Abstract Introduction With increasing numbers of pharmacists working in general practices [also called general practice-based pharmacists (PBPs)] and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills (clinical examination and procedural skills) (1). However, previous studies have highlighted that PBPs do not feel confident regarding their clinical skills, and it is unclear what skills are needed (1). Aim To develop a core set of clinical skills required for pharmacists who intend to practise as independent prescribers working in general practice. Methods Based on a previous study (2), 18 clinical skills were selected for inclusion in a three-round Delphi consensus questionnaire. Designated leads (n=54) of pharmacist independent prescribing programmes in each United Kingdom (UK) educational provider (n=47) listed on the General Pharmaceutical Council website were invited to participate in March 2021. Following consent, a web-based questionnaire was distributed by email in April 2021 (Round 1). Two subsequent rounds were distributed in May and June 2021 respectively, and comprised the clinical skills for which consensus had not been achieved previously. A 9-point Likert scale was used (ranging from 1=limited importance to 9=critical). The response rate and distribution of scores for each clinical skill were calculated after each round. A clinical skill was included in the core set if 80% or more of participants scored between 7- 9, and 15% or less scored between 1-3. Results From 24 recruited participants (44.4%), 21 participants (87.5%) from 20 providers responded to Round 1 of the questionnaire, and also responded to the second and third rounds (100%). Following Round 1, seven clinical skills met the criteria for inclusion. Two additional clinical skills suggested by participants were added to the list of 11 clinical skills for which no consensus had been reached in the first round, hence, a total of 13 clinical skills were presented in Round 2. Two further skills were added to the core set following the second and third rounds respectively (four in total). The final core set consisted of 11 clinical skills: ‘Measuring heart rate (radial pulse)’, ‘Assessing respiratory rate’, ‘Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)’, ‘Measuring blood pressure (automated, i.e. electronic blood pressure monitor)’, ‘Measuring peripheral oxygen saturation (using pulse oximeter)’, ‘Measuring temperature’, ‘Undertaking a urinalysis’, ‘Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)’, ‘Measuring Peak Expiratory Flow Rate’, ‘Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)’, and ‘Patient assessment via National Early Warning Score (NEWS)’. No consensus was reached on nine clinical skills. Conclusion This study has produced a core set of clinical skills for prescribing PBPs. The study was entirely UK-based, thus findings may not be generalisable to other countries. Moreover, a lower threshold for consensus would have led to the inclusion of more skills. However, this core set can serve as a reference for other countries developing policies on pharmacist roles. Furthermore, this study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice. References (1) Girvin B, Wilson D. Clinical skills training for pharmacists in general practice. Prescriber. 2018 Dec 11; 29(12): 19-25. (2) Girvin B, Akpan U, Hampson N, Middleton H, Sims L, Barry H. Establishing the roles undertaken and clinical skills needed by general practice-based pharmacists: a web-based survey. Pharm Educ. 2020 Sep 4; 20(1): 253.

Primary Care Nurse Practitioner Clinical Procedural Skills

This online survey study examined the most frequently performed and most important clinical procedural skills (CPSs) and location of CPSs training in a sample of 102 primary care nurse practitioners across a 6 state/jurisdiction region of the United States. Results indicated that 7 CPSs were reported as being performed at least once a week by > 30% of participants, and the same 7 CPSs were reported as very important by > 50% of participants. Results facilitate formation of a list of core CPSs for primary care nurse practitioners for standardization of CPSs curricular requirements.

A flipped classroom, same-level peer-assisted learning approach to clinical skill teaching for medical students.

BackgroundClinical procedural skills are vital components of medical education. Increased student intake and limited capacity of medical schools necessitate more efficient ways to deliver clinical skill teaching. This study employed a flipped classroom, peer-assisted learning approach to deliver clinical skill teaching. It aimed to determine the influence of pre-class demonstration video watching and in-class student-student interactions on clinical skill acquisition.MethodsIn 2017, a cohort of 205 medical students in their penultimate year of undergraduate medical study were recruited, and they learned bag mask ventilation and intravenous cannulation during this study. The participants watched a demonstration video before class, and then underwent self-directed practice as triads. Afterwards, each participant video-recorded their skill performance and completed post-class questionnaires. The videos were evaluated by two blinded assessors.ResultsA hundred and thirty-one participants (63.9%) completed the questionnaire. For bag mask ventilation, participants who claimed to have watched the corresponding demonstration video before class achieved higher performance scores (those who watched before class: 7.8 ± 1.0; those who did not: 6.3 ± 1.7; p < 0.01). For intravenous cannulation, while there is no significant difference in performance scores (those who watched before class: 14.3 ± 1.3; those who did not: 14.1 ± 1.4; p = 0.295), those who watched the video before class received less interventions from their peers during triad practice (those who watched before class: 2.9 ± 1.8; those who did not: 4.3 ± 2.9; p < 0.05). The questionnaire results showed that most participants preferred the new approach of clinical skill teaching and perceived it to be useful for skill acquisition.ConclusionThe flipped classroom, same-level peer-assisted learning model is potentially an effective way to address the current challenges and improve the efficiency of clinical procedural skill teaching in medical schools.

1636 Improving Plastics SHO Induction: A Three-Cycle QI Project and National Survey

Abstract Aim Burns and Plastic Surgery is a wide-ranging exciting field that is rarely taught well in undergraduate medical curriculums. As such, it is imperative that we design and deliver a safe and effective induction programme for Foundation doctors and core trainees who are new to this specialty. Method Plastics SHOs rotating to our unit from December 2019 to December 2021 completed quantitative and qualitative questionnaires on the departmental induction they received. Statistical analysis and thematic analysis of their quantitative and qualitative responses were performed respectively. We aimed to describe the process of modifying our induction programme to the modern learner's learning needs. In addition, we surveyed Plastics SHOs in all Plastics units in the UK to compare and assimilate best practice. Results A combination of didactic and practical workshops resulted in significantly improved learner satisfaction, SHO preparedness for oncalls and knowledge of departmental policies in our unit. SHO shadowing was the most preferred and effective method of SHO induction nationally but rarely used. SHO handbooks were useful but employed by less than 40% of Plastics units nationally. Conclusions Through a multi-cycle QI project and national survey, we look forward to presenting the ideal design of an SHO induction programme for a specialty that requires structured clinical assessment and procedural skills. In summary, the ideal SHO induction programme consists of a combination of didactic tutorials, practical workshops, and peer shadowing. This is crucial in maintaining patient safety and junior doctor well-being when tackling the often-busy plastic surgery oncalls.

The Impact of Community Service Experience on the Undergraduate Students’ Learning Curve and Subsequent Changes of the Curriculum- A Quality Improvement Project at a Caribbean Medical University

Background: Community service learning seems to positively impact undergraduate medical students’ practical procedural and communications skills. Events like health fairs also strengthen the bond between healthcare providers and the wider community. Recognizing this mutually beneficial situation, national accreditation agencies and medical boards have recommended incorporating community-based learning in the core undergraduate curriculum. Our university is the first to probe medical students’ perceptions of community service in our region to the best of our knowledge.Objectives: We sought to analyze the experience of our students to improve the practical value of the curriculum.Methods: This was a qualitative survey interviewing medical students volunteering at a health fair in a Caribbean Island aimed to screen gross cardio-vascular and metabolic abnormalities in the native adult population. The focus group interviews were processed, transcribed and coded for thematic analyses by independent observers.Results: Overall, the students perceived CS as an opportunity to improve their clinical procedural and communications skills and to apply theoretical medical knowledge in practice to detect undiagnosed conditions like diabetes mellitus, hypertension and nutritional imbalance.Pedagogical implications: We have increased practical laboratory sessions by 15% in the new semester to improve our students’ practical skills.Conclusions: This is the first study that describes how community service may influence the individual learning curve of undergraduate medical students and may serve as a quality improvement tool to guide amendments to the curriculum. We opine that inter-agency, community-focused service promotes social, peer and active learning amongst undergraduate medical students.

Teaching patient-centred communication skills during clinical procedural skill training - a preliminary pre-post study comparing international and local medical students

BackgroundInternational medical students are frequently confronted with intercultural, psychosocial, and language barriers and often receive lower marks in written, oral, and clinical-practical examinations than fellow local students. Training communication competence in procedural skills, such as blood sampling, is further challenge in this particular group of medical students. This pre-post comparative intervention study aimed to investigate the effects of training communication skills during the performance of procedural skills (taking blood samples from a silicone model) in international and local students as part of their clinical practical medical training.MethodsStudy participants performed blood sampling on an arm prosthesis model (part-task trainer) before and after the communication skills training, focusing on accompanying communication with a simulation patient sitting next to the arm model. The pre- and post-evaluation video was assessed by two independent evaluators using a binary checklist, the Integrated Procedural Performance Instrument (IPPI) and global assessments of clinical professionalism in terms of procedural and communication performance. Linear models with mixed effects were used. Group differences regarding global competence levels were analysed with χ2-tests.ResultsInternational medical students did not perform as well as their local counterparts in the pre- and post-examinations. Both groups improved their performance significantly, whereby the international students improved more than their local counterparts in terms of their communication performance, assessed via binary checklist. Clinical professionalism evaluated via global assessments of procedural and communication performance highlights the intervention’s impact insofar as no international student was assessed as clinically not competent after the training.ConclusionsOur results suggest that already a low-dose intervention can lead to improved communication skills in medical students performing procedural tasks and significantly increase their confidence in patient interaction.